Veress needle with illuminated guidance and suturing capability

ABSTRACT

A laparoscopic instrument for forming an incision in a body cavity, insufflating the body cavity with gas, and suturing the incision at the completion of the surgery includes a set of jaws at the distal end of the Veress needle or cannula. The jaws are pivoted to one another for motion between an open position or a closed position in which they may be used to grasp a suture in the body cavity for removal from the cavity for knotting. A push mechanism at the proximal end of the instrument moves the jaws between their open and closed position on successive actuations of a pushbutton and retains them in that state until the next push. An illumination source is provided for the distal end of the instrument to provide illumination through the walls of the body cavity so that the surgeon can determine the degree of penetration of the instrument into the body cavity and can identify any major arteries which should be avoided in the formation of other laparoscopic openings.

CROSS-REFERENCE TO RELATED APPLICATIONS

This Application is a Continuation in Part of application Ser. No.12/693,079 filed on Jan. 25, 2010. Application Ser. No. 12/693,079claims the benefit of U.S. Provisional Application 61/146,974 filed onJan. 23, 2009.

FIELD OF THE INVENTION

This invention relates to an instrument for use in the practice oflaparoscopic surgery and more particularly to such a device which hasutility in forming an incision, insufflating the underlying body cavityand suturing the incision at the completion of the surgery.

BACKGROUND OF THE INVENTION

In the practice of minimally invasive laparoscopic surgery it is commonto make a small incision through the skin and underlying tissue of thepatient adjacent the internal surgical site using a Veress needle. Theseneedles include a tubular outer cannula with a sharpened distal end andan inner hollow cylindrical needle which terminates in a blunt end. Aspring assembly urges the needle to a position in which the blunt end ofthe needle is extended beyond the cutting edge of the cannula. When theinstrument is pressed against the skin of the patient the blunt end isresisted by the skin so that the outer cannula moves over the blunt endand forms a small incision in the skin and underlying tissue of thepatient. When the pressure on the Veress needle is removed, the needleslides forward, leaving a blunt end within the body of the patient, sothat the accidental cutting of underlying organs is avoided.

The Veress needle typically includes means for introducing pressurizedgas, usually CO₂, into the proximal end of the needle so that the gas ispassed on into the laparoscopic incision and inflates the body cavity toallow easy access to the surgical site. A trocar which surrounds thecannula and frames the proximal side of the incision may be left inplace after the cannula is withdrawn to provide an instrument port witha seal to prevent the escape of the insufflating gas.

After formation of a first incision and insufflation of the body cavity,a second incision, nearby but spaced apart from the first incision, isformed and typically used for insertion of a remote imaging endoscope toallow the surgeon to visualize the internal surgical site. A thirdincision allows the insertion of an operating instrument.

When the surgery is completed it is necessary to suture one or more ofthe laparoscopic incisions. Suturing typically involves an instrumentthat can carry a suture thread into the body cavity and allow the threadto be pulled outwardly through the incision. At the proximal side of thesurgical site two ends of the suture are knotted together to secure theincision.

One problem associated with the use of such Veress needle assemblies isdetermining when the needle has progressed through the wall of the bodycavity and its distal end has emerged within the cavity. Additionally,there is a need to determine the location of significant blood vesselsin the cavity wall so that the incision made by the needle, as well asthe additional incisions necessary to perform the surgery, can be madewithout cutting these vessels.

SUMMARY OF THE INVENTION

A first embodiment of the invention, which will subsequently bedisclosed in detail, comprises a Veress needle in which the central tubeor the rod of the needle supports a grasper at its distal end comprisinga pair of pivoted forceps jaws which are normally retained in a closedposition by a spring, but may be opened by manual pressure applied to abutton at the proximal end of the needle. By opening the jaws,positioning them about a suture line, and depressing the button again,to cause the jaws to clamp on the suture line, a suture may be securedand one end of the suture may be carried externally of the incision bywithdrawing the needle.

In another embodiment of the present invention the distal end of thecentral tube of the Veress needle terminates in a “crochet hook” endfacing the proximal end of the needle. The instrument and the suture maybe manipulated so that the suture is caught within the hook and drawnout of the incision when the Veress needle is removed. The distal endalso has a needle hole through which a suture thread may be passed tocarry it into the body cavity.

The preferred embodiment of the invention includes a cam mechanismsupported at the proximal end of the instrument which allows the twojaws which make up the hook to be disposed in either an open position,in which the jaws are separated, or a closed position in which the jawsare closed, or closed about a suture. The mechanism includes a button atthe proximal end of the instrument which may be depressed to move thehook between its opened and closed positions. With each depression, thehook is moved between its open and closed positions and remains in thatstate until the button is again depressed, moving the jaws to the otherposition. This allows a surgeon to manipulate the present instrumentwith a single hand.

Another aspect of the present invention, illustrated in connection withanother embodiment of the invention, comprises an illuminating systemfor incorporation in a Veress needle assembly which allows the surgeonto visualize the progress of the trocar in forming a laparoscopicincision; aids in the visualization of major blood vessels in theincision area; and, in certain embodiments, provides illumination of theinsufflated body cavity to aid in endoscopic visualization of thecavity. These illuminating systems can be incorporated in conventionalVeress needle devices as well as the version incorporating the suturingcapability.

The illumination system typically employs a bright, small, illuminationsource such as an LED, although a conventional laser separated from theneedle may provide the illumination through an optical fiber. The LEDmay be located at the proximal end of the Veress needle and cooperatewith a hollow tube of a light-conducting plastic such as Lucite, whichmay form part of the outer cannula, having an appended sharpened endformed of either metal or the tube plastic at its distal end.

In still another embodiment the light source could be located adjacentto the distal end of the cannula and powered by electrical leads passingthrough the cannula from the proximal end.

The illumination at the distal end of the needle allows the position ofthe distal end to be visualized by the surgeon through the translucentbody tissues. That is, the light from the distal end will pass throughthe body tissues and allow the surgeon to observe the distal tip of thetrocar to determine when it clears the inner wall of the body cavity. Itwill also aid in identification of major blood vessels which mightinterfere with the formation of additional incisions required forlaparoscopic surgery.

BRIEF DESCRIPTION OF THE DRAWINGS

Other objects, advantages and applications of the present invention willbe made apparent by the following detailed description. The descriptionmakes reference to the accompany drawings in which:

FIG. 1 is a cross-sectional view through a preferred embodiment of theinstrument, with the suture engaging jaws in an open position;

FIG. 1A is a cross-sectional view along line 1A of FIG. 1 illustratingthe hook opening and closing mechanism;

FIG. 2 is a cross-sectional view of the device of FIG. 1 with the endhook in a closed position;

FIG. 2A is a cross-sectional view through the device of FIG. 2 alongline 2A, again illustrating the hook unlocking and opening mechanism;

FIG. 3 is a cross-sectional view of the device constituting a preferredembodiment of the invention, illustrating its operation as a Veressneedle forming an incision through a body cavity;

FIG. 4 is a side view of the preferred embodiment of the instrumentshowing it penetrating wall of a body cavity;

FIG. 5 is a side view of the instrument of the present invention showingit grasping a suture;

FIG. 6 is a perspective, partially broken-away view of the end hookopening and closing mechanism;

FIG. 7 is an exploded perspective view of the hook-actuating mechanism;

FIG. 8 is a side view, partially broken away, of an alternativeembodiment of the invention, comprising an LED positioned at theproximal end;

FIG. 9 is a side view, partially broken away, of an embodiment of theinvention comprising an LED positioned at the distal end; and

FIGS. 10A, B, and C are side views of the variations of the notch whichmay be employed with alternative embodiments of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

A preferred embodiment of the invention, illustrated in FIGS. 1 and 2,acts as a Veress needle to form an incision into a body cavity, as aninsufflator to inject gas into the cavity, and as a suture manipulatorto close up the incisions made during the endoscopic process.

The instrument, generally indicated at 10, has a handle 12 at theproximal end, which supports one end of the Veress needle, constitutingan elongated cannula tube 14 with a sharpened trocar 16 at the distalend. A tubular needle having a diameter complementary to the diameter ofthe cannula 14 is supported within the cannula.

The distal end of the needle 18 carries one fixed jaw 20 of a sutureengaging jaw set. The other jaw member 22 is pivotably connected to thejaw 20 at pivot point 24. A lever arm 26 formed on the jaw 22 connectsto one end of a rod 28 which passes through the center of the needlewith its proximal end terminating in the handle area 12 at an extensionand retraction mechanism which will be subsequently described. When themechanism extends the rod 28, the jaw 22 moves into a closed positionwith respect to the jaw 20, as is illustrated in FIG. 2. When themechanism retracts the rod 28, the jaws are opened as shown in FIG. 1.

The ends of the jaws 20 and 22 are rounded and blunt. The needle 18 isbiased toward the distal end of the cannula 14 by a spring 21 supportedin the handle area 12 so that the hook formed by the sections 20 and 22projects out of the distal end of the cannula. When the instrument 10 ispressed against a wall 32 of a body cavity, in the manner illustrated inFIG. 3 or FIG. 4, and the hook ends are closed, they are forced upwardlyagainst the spring 21 by the contact with the surface of the cavity 32.Thus the sharpened trocar end 16 is forced downwardly beyond the jawsand forms an incision in the body wall 32, in the manner illustrated inFIG. 4.

The body cavity 34 may then be insufflated by gas, preferably CO₂,passed through a valve 38 into the interior of the central needle,through the needle, and out the distal end.

The position of the rod 28, which moves the hook between the open andclosed positions, is controlled by an extension-retraction mechanismlocated within the handle 12. A button 42 at the proximal end of theinstrument may be depressed by the thumb of the surgeon while twofingers are engaged around the wings 44 of the instrument. The button isnormally biased toward extension by a spring 46. The mechanism, which isof the type illustrated in U.S. Pat. No. 4,991,998, the contents ofwhich are hereby incorporated for reference, includes a plunger 50having an extension 52 at its top end. The plunger moves within acentral bore 54 formed in the handle member 12. The opposite end of theplunger 50 includes six laterally extending guides 56 which interactwith rails 58 formed on the interior of the cavity 54. The interactionbetween the guides 56 and the rails 58 restrains the plunger towardlongitudinal, non-rotational movement within the handle cavity 54.

A ratchet 60 has a hub 62 from which three guides 64 extend radially.The ratchet 60 has a stem portion 66 which fits within a central void 68in the plunger 50. Tapered teeth on the upper sides of the three guides64 engage tapered surfaces on the lower ends of the teeth 58. Thus, whenratchet 60 is inserted into the bore 68 of the plunger 50, the taperedteeth of the plunger and of the ratchet will engage each other and alignthe parts.

The design of the teeth on the plunger 50, the ratchet 60, and themechanism on the interior of the interior bore 54 and handle member 12cause the ratchet 60 to rotate slightly when released from the teeth 58upon depression of the pushbutton 42 against the upper surface of theplunger 50 and to rotate again when the pushbutton is released so thatthe teeth 64 engage the teeth 58. The ratchet teeth alternately movefrom a first position on the teeth 58 into a second position where theteeth 64 slide into the slots between the teeth 58. The ratchet rotatesslightly when depressed by the plunger 50 and again on the teeth 58 whenthe plunger is withdrawn, causing a circular movement that permits therod 28 to be extended and retracted, thus closing and opening the jaws20 and 22 and retaining them in that position until the next depressionof the pushbutton 42.

Another embodiment of the invention is illustrated in FIG. 8. Thisversion provides a light source at the lower end of a clear polymer rodor tube 80, which extends within a stainless steel hollow tube 82 with asharp tip 84 on its distal end. A spring 86 biases the interior rod 80into a position in which its distal end extends outwardly from the tip84, as illustrated in FIG. 8. Again, when the rounded end of the fiberoptic tube 80 is pressed against the body cavity, the tube 80 retractsagainst the spring and allows the sharp tip to cut into a body cavityand reach an operating site.

The tip of the polymer rod 80 is formed with a hook “crochet needle”notch 90, which is adapted to catch a suture and allow it to bewithdrawn from the body cavity, as well as a needle hole 91 for carryinga suture into the body cavity. FIGS. 10A, B, and C illustrate variationsof the notch which may be employed with alternative embodiments of theinvention. Each of the variations includes a narrow passage 120A, 120B,or 120C respectfully formed on the side of rod 80, closely above itsdistal end. The passages have a width slightly greater than the diameterof the suture. The passages open into triangular sections 122A, B and Cconnected to the passages at one corner and having acute angles 124A, B,and C at their other corners. After a suture passes through one of theside openings 120, it may be securely engaged by the rod beingmanipulated so that the suture is captured in one of the corners 124.

An illumination source 92, preferably taking the form of an LED, isdisposed in the proximal end of the instrument within a housing 94.

A battery 96 is also supported in the housing and is connected by leads98 to the LED 92 through an on-off switch 99. The light from the LED isgathered by a surface 100 and transmitted through the polymer rod 80.The distal end of the rod is polished to produce a light output at thatend. The housing 94 is equipped with a gas intake tube and gas valve 38to allow the insufflation of a body cavity after penetration by the tube82.

As the surgeon penetrates the body cavity with the device, the polishedtip of the rod 80 will provide illumination that is visible through thetranslucent walls of the cavity, indicating to the surgeon the locationof the tip. The surgeon can use that to determine when the device haspenetrated into the body cavity and also to identify any major arteriesin the cavity wall which should be avoided in the formation ofadditional laparoscopic openings.

FIG. 9 shows still another embodiment of the invention, generallysimilar to the device of FIG. 8, with the exception of the fact that theLED 110 is located on the distal tip of the rod 80 and is poweredthrough conductors 112 from a battery 114 supported at the proximal end.

In alternate embodiments of the invention, not shown, a laser of someform other than an LED can be disposed externally of the laparoscopicinstrument and the illumination source can be provided by a fiber opticleading from that laser to the desired location of the illuminationsource.

Having thus disclosed my invention I claim:
 1. A device for use inlaparoscopic surgery adapted to form an incision in a body cavity,insufflate the cavity with gas through the incision, and draw suturesthrough the incision to close off the incision, comprising: an elongatedcannula having a handle at a proximal end and a sharpened trocar at adistal end; a tubular Veress needle having a proximal end and a distalend supported within the cannula; a pair of suture-engaging jawsdisposed at the distal end of the Veress needle; a gas valve forintroduction of gas at the proximal end of the Veress needle for passagethrough an incision formed by the trocar into a body cavity; a controlwire connecting the suture-engaging jaws to the proximal end of thecannula; and a pushbutton actuated extension-retraction mechanismconnected to the control wire at the proximal end of the cannula andadapted to move the control wire between extended and retractedpositions.
 2. The device of claim 1 further comprising an illuminationsource operative to provide illumination to the distal end of the devicethrough a clear polymer Veress needle.
 3. The device of claim 2 in whichthe illumination source is an LED.
 4. The device of claim 1 furthercomprising an illumination source disposed at the proximal end of thedevice and wherein said cannula is formed of light-conducting plasticwhich carries the illumination to the distal end of the device.
 5. In anelongated device for laparoscopic surgery comprising a handle member atthe proximal end and a distal end, the improvement comprising anillumination source operative to provide light at the distal end whichis visible to a surgeon using the device to determine the position ofthe distal end within an operating site in a body cavity.
 6. The devicefor laparoscopic surgery of claim 5 wherein the illumination source isdisposed at the proximal end and transmitted to the distal end through alight transmissive plastic member extending from the illumination sourceto the distal end.
 7. The device for laparoscopic surgery of claim 5 inwhich the illumination source comprises an LED disposed at the distalend powered by a battery supported at the proximal end and connected tothe LED through conductors extending between the ends of the device. 8.In a device for use in laparoscopic surgery adapted to form an incisionin a body cavity and inflate the cavity with gas passed through theincision, the improvement comprising an elongated member extendingthrough the device from the proximal to the distal end and having arounded distal end and a slot formed in the member adjacent to the end,the slot having tapered sides with a maximum width at the outer surfaceof the member and a minimum width at the interior end, with the slotoriented in the general direction of the proximal end, the slot beingadapted to capture a length of suture thread for withdrawal through theincision.
 9. In a device for use in laparoscopic surgery adapted to forman incision in a body cavity and inflate the cavity with gas passedthrough the incision, the improvement comprising an elongated memberextending through the device from the proximal to the distal end andhaving a rounded distal end and a slot formed in the member adjacent tothe end the slot having a triangular shape with two acute interiorangels and a passage from the third angle to the side of the elongatedmember adjacent to its distal end.